Citation Nr: 0817599
Decision Date: 05/29/08 Archive Date: 06/09/08
DOCKET NO. 06-02 869 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Lincoln,
Nebraska
THE ISSUES
1. Evaluation of a service-connected right shoulder strain,
rated as 20 percent disabling.
2. Evaluation of service-connected mid-thoracic back strain,
rated as noncompensably (zero percent) disabling.
3. Evaluation of service-connected low back strain, rated as
noncompensably (zero percent) disabling.
4. Evaluation of service-connected left shin splints, rated
as noncompensably (zero percent) disabling.
5. Evaluation of service-connected right shin splints, rated
as noncompensably (zero percent) disabling.
6. Evaluation of service-connected post-traumatic stress
disorder (PTSD), rated as 30 percent disabling from March 6,
2005, and rated as 50 percent disabling from August 3, 2006.
7. Entitlement to service connection for a left shoulder
disability.
8. Entitlement to service connection for a left knee
disability.
9. Entitlement to service connection for a right knee
disability.
10. Entitlement to service connection for a sinus
disability.
11. Entitlement to service connection for a neck disability.
12. Entitlement to service connection for hearing loss.
REPRESENTATION
Appellant represented by: Richard J. Mahlin, Attorney at
Law
ATTORNEY FOR THE BOARD
Van Stewart, Counsel
INTRODUCTION
The veteran had active service in the Marine Corps from July
1999 to March 2005. Service in Southwest Asia is indicated
by the evidence of record.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal of September 2005 and December 2005 rating
decisions by the Department of Veterans Affairs (VA) Regional
Office (RO) in Lincoln, Nebraska.
The United States Court of Appeals for Veterans Claims
(Court) has indicated that a distinction must be made between
a veteran's dissatisfaction with an initial rating assigned
following a grant of service connection (so-called "original
ratings"), and dissatisfaction with determinations on later
filed claims for increased ratings. See Fenderson v. West,
12 Vet. App. 119, 125-26 (1999). When an original rating is
appealed, consideration must be given as to whether an
increase or decrease is warranted at any time since the award
of service connection, a practice known as "staged"
ratings. Id. Inasmuch as the rating questions currently
under consideration were placed in appellate status by
notices of disagreement expressing dissatisfaction with
original ratings, the Board has characterized those issues as
set forth on the title page.
The Board notes that the veteran's attorney contends that an
issue on appeal is entitlement to an effective date earlier
than August 3, 2006, for award of a 50 percent evaluation for
service-connected PTSD. The Board notes, however, that,
because the PTSD rating issue comes following the award of
service connection and the assignment of an initial rating,
consideration of whether a higher rating is warranted, such
as the 50 percent award, must be undertaken since the award
of service connection, which was March 6, 2005. Fenderson,
supra. In other words, when considering the possibility of
"staged" ratings, the Board's analysis must include whether
the 50 percent rating, or even higher, was warranted before
the August 3, 2006, effective date already set by the RO.
(No question regarding the effective date of the award of
service connection was developed for the Board's review.)
FINDINGS OF FACT
1. The veteran's service-connected right shoulder strain is
evidenced by very mild tenderness, range of motion elevation
and abduction both to 180 degrees, with some discomfort from
150 to 180 degrees.
2. The veteran's mid-thoracic back strain is evidenced by
only minimal tenderness to deep palpation to the area between
the shoulder blades, and no muscle spasms.
3. The veteran's low back strain is evidenced by some
tenderness to palpation over the left sacroiliac joint,
negative straight leg raises, full flexion to 90 degrees.
4. The veteran's left shin splints are evidenced by no
objective signs or symptoms.
5. The veteran's right shin splints are evidenced by no
objective signs or symptoms.
6. The veteran's PTSD is manifested by trouble getting to
sleep, no inappropriate behavior, no obsessive/ritualistic
behavior, no panic attacks, no homicidal/suicidal thoughts,
and no symptoms that result in deficiencies in judgment,
thinking, family relations, work, mood, or school.
7. The veteran does not have a left shoulder disability that
is related to his military service.
8. The veteran does not have a left knee disability that is
related to his military service.
9. The veteran does not have a right knee disability that is
related to his military service.
10. The veteran does not have a sinus disability that is
related to his military service.
11. The veteran does not have a neck disability that is
related to his military service.
12. The veteran does not have impaired hearing as defined by
VA.
CONCLUSIONS OF LAW
1. The criteria for an increased rating for the veteran's
right shoulder strain have not been met. 38 U.S.C.A. § 1155
(West 2002); 38 C.F.R. §§ 4.1, 4.10, 4.14, 4.40, 4.45, 4.7,
4.71a, Diagnostic Code 5201 (2007).
2. The criteria for a compensable rating for the veteran's
mid-thoracic back strain have not been met. 38 U.S.C.A.
§ 1155; 38 C.F.R. §§ 4.1, 4.10, 4.14, 4.40, 4.45, 4.56, 4.7,
4.71a, Diagnostic Code 5323 (2007).
3. The criteria for a compensable rating for the veteran's
low back strain have not been met. 38 U.S.C.A. § 1155;
38 C.F.R. §§ 4.1, 4.10, 4.14, 4.40, 4.45, 4.7, 4.71a,
Diagnostic Code 5237 (2007).
4. The criteria for a compensable rating for the veteran's
left shin splints have not been met. 38 U.S.C.A. § 1155;
38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Code 5262 (2007).
5. The criteria for a compensable rating for the veteran's
right shin splints have not been met. 38 U.S.C.A. § 1155;
38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Code 5262.
6. The criteria for a rating in excess of 30 percent for
PTSD from March 6, 2005, or for a rating in excess of 50
percent from August 3, 2006, have not been met. 38 U.S.C.A.
§ 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.14, 4.130, Diagnostic
Code 9411 (2007).
7. The veteran does not have a left shoulder disability that
is the result of disease or injury incurred in or aggravated
during active military service. 38 U.S.C.A. §§ 1101, 1110,
1112, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304,
3.307, 3.309 (2007).
8. The veteran does not have a left knee disability that is
the result of disease or injury incurred in or aggravated
during active military service. 38 U.S.C.A. §§ 1101, 1110,
1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.
9. The veteran does not have a right knee disability that is
the result of disease or injury incurred in or aggravated
during active military service. 38 U.S.C.A. §§ 1101, 1110,
1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.
10. The veteran does not have a sinus disability that is the
result of disease or injury incurred in or aggravated during
active military service. 38 U.S.C.A. §§ 1101, 1110, 1112,
5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.
11. The veteran does not have a neck disability that is the
result of disease or injury incurred in or aggravated during
active military service. 38 U.S.C.A. §§ 1101, 1110, 1112,
5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.
12. The veteran does not have hearing loss that is the
result of disease or injury incurred in or aggravated during
active military service. 38 U.S.C.A. §§ 1101, 1110, 1112,
1154(a), 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304,
3.307, 3.309, 3.385 (2007).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
I. Veterans Claims Assistance Act of 2000
The Veterans Claims Assistance Act of 2000 (VCAA) describes
VA's duty to notify and assist claimants in substantiating a
claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103,
5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R.
§§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007).
Upon receipt of a complete or substantially complete
application for benefits, VA is required to notify the
claimant and his representative of any information, and any
medical or lay evidence, that is necessary to substantiate
the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b);
Quartuccio v. Principi, 16 Vet. App. 183 (2002). The VCAA
notice must inform the claimant of any information and
evidence not of record (1) that is necessary to substantiate
the claim; (2) that VA will seek to provide; (3) that the
claimant is expected to provide; and (4) must ask the
claimant to provide any evidence in his possession that
pertains to the claim in accordance with 38 C.F.R.
§ 3.159(b)(1). VCAA notice should be provided to a claimant
before the initial unfavorable agency of original
jurisdiction (AOJ) decision on a claim. Pelegrini v.
Principi, 18 Vet. App. 112 (2004). But see Mayfield v.
Nicholson, 19 Vet. App. 103, 128 (2005), rev'd on other
grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir.
2006) (when VCAA notice follows the initial unfavorable AOJ
decision, subsequent RO actions may "essentially cure[] the
error in the timing of notice").
The Board notes that the veteran was apprised of VA's duties
to both notify and assist in correspondence dated in April
and August 2005, and March 2006. (Although the complete
notice required by the VCAA was not provided until after the
RO adjudicated the appellant's claims, any timing errors have
been cured by the RO's subsequent actions and a
readjudication. Id.)
Specifically regarding VA's duty to notify, the notifications
to the veteran apprised him of what the evidence must show to
establish entitlement to the benefits sought, what evidence
and/or information was already in the RO's possession, what
additional evidence and/or information was needed from the
veteran, what evidence VA was responsible for getting, and
what information VA would assist in obtaining on the
veteran's behalf. The RO specifically requested that the
veteran submit any evidence he had pertaining to his claims.
The veteran was apprised of the criteria for assigning
disability ratings and for award of an effective date. See
Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The
RO also provided a statement of the case (SOC) regarding each
appealed issue reporting the results of its reviews of the
issues on appeal and the text of the relevant portions of the
VA regulations.
Regarding VA's duty to assist, the RO obtained the veteran's
service medical records (SMRs) and post-service medical
records, and secured examinations in furtherance of his
claims. VA has no duty to inform or assist that was unmet.
II. Rating Issues
Disability ratings are determined by applying the criteria
set forth in the VA Schedule for Rating Disabilities (Rating
Schedule), found in 38 C.F.R. Part 4. The Board attempts to
determine the extent to which the veteran's service-connected
disability adversely affects his ability to function under
the ordinary conditions of daily life, and the assigned
rating is based, as far as practicable, upon the average
impairment of earning capacity in civil occupations. 38
U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10. Where there is a
question as to which of two evaluations should be applied,
the higher evaluation will be assigned if the disability
picture more nearly approximates the criteria required for
that rating. Otherwise, the lower rating will be assigned.
38 C.F.R. § 4.7. When a specific disability is not listed in
the rating schedule, rating is done by analogy to a closely
related disease or injury in the Rating Schedule in which not
only the functions affected, but the anatomical location and
symptomatology are closely analogous. 38 C.F.R. § 4.20
(2007).
As noted above, the Court has indicated that a distinction
must be made between a veteran's dissatisfaction with
original ratings and dissatisfaction with determinations on
later filed claims for increased ratings. Fenderson, supra.
Consequently, the Board will evaluate the veteran's right
shoulder strain, mid-thoracic back strain, low back strain,
left and right shin splints claims as claims for higher
evaluations of original awards, effective from the date of
award of service connection. Because the RO has staged the
veteran's PTSD ratings, the Board's analysis of the PTSD
issue requires consideration of the ratings to be assigned
effective from the date of award of service connection, in
this case, March 6, 2005, the day following separation from
military service. 38 C.F.R. § 3.400 (2007).
In determining the degree of limitation of motion, several
regulatory provisions are taken into consideration: the
provisions of 38 C.F.R. § 4.40 concerning lack of normal
endurance, functional loss due to pain, and pain on use and
during flare-ups; the provisions of 38 C.F.R. § 4.45
concerning weakened movement, excess fatigability, and
incoordination; and the provisions of 38 C.F.R. § 4.10
concerning the effects of the disability on the veteran's
ordinary activity. See DeLuca v. Brown, 8 Vet. App. 202
(1995). The evaluation of the same disability under various
diagnoses is to be avoided. 38 C.F.R. § 4.14. Here, as will
be seen below, the effects of pain on use, functional loss,
and incoordination were taken into account in assessing the
range of motion of the veteran's service-connected joint
disabilities.
A. Right Shoulder Strain
The veteran injured his right shoulder apparently while
changing a helicopter rotor blade in service. His SMRs show
the result was an acromioclavicular (AC) joint separation.
At a VA medical examination conducted in June 2005, he
reported pain with movement, and weakness, with resultant
difficulty in working out while lifting weights overhead. He
reported pain primarily with motion and repetitive use, but
reported that he took no medications, and had had no
injections or surgeries. On examination, there was very mild
tenderness to deep palpation of the anterior and superior
aspect of the right shoulder. Range of motion testing
revealed forward elevation and abduction both performed to
180 degrees, and both with discomfort beginning at 150
degrees. External and internal rotation were both to 90
degrees bilaterally, with some discomfort beginning at 75
degrees. There was mild fatigability and mild to moderate
pain with repetitive range of motion; there was no weakness
or incoordination. The veteran was afforded another VA
examination in January 2007 by the same physician that
yielded identical results.
The RO sought a VA neurological medical opinion to determine
the source of the veteran's complained-of headaches. The
opinion, dated in October 2005, noted that after review of
all of the veteran's records, including computerized medical
records, it was determined that the veteran's headaches
appeared to be of a muscle tension type due to muscle strain.
This physician opined that it is at least as likely as not
that the veteran's current headaches were related to his
service-connected right shoulder strain and mid-thoracic back
strain. The physician provided a medical rationale, and also
noted that it is well known in the medical literature that
these types of muscle strain can easily cascade to the
posterior cervical spine, causing tension and muscle
contraction-type headaches, which can easily cause the
discomfort the veteran reported. (Service connection for
headaches was granted by a January 2006 rating decision; this
issue is not before the Board on appeal.)
The veteran's right shoulder disability is evaluated
utilizing the rating criteria found at Diagnostic Code 5201,
limitation of motion of the arm. 38 C.F.R. § 4.71a. The
record shows that the veteran is right handed. Under
Diagnostic Code 5201, a 20 percent evaluation is for
application when range of motion of the major arm (related to
"handedness") is limited to shoulder level. A 30 percent
evaluation is for application when range of motion of the arm
is limited to midway between the side and shoulder level. A
40 percent evaluation is for application when motion of the
arm is limited to 25 degrees from the side.
Here, the evidence of record shows that the veteran's
disability picture more nearly approximates the currently
awarded 20 percent, and that a higher rating is not
warranted. 38 C.F.R. § 4.7. Award of the higher, 30
percent, rating would require a showing that the veteran's
right arm range of motion was limited to midway between the
side and shoulder level. Both examinations revealed that the
veteran's range of motion was unlimited, that is, he was able
to raise his arm to 180 degrees. Even taking into account
DeLuca, supra, the Board notes that both examinations showed
discomfort beginning at 150 degrees, which is well above
shoulder level, indicating that the threshold requirement for
award of the 20 percent rating currently awarded has not been
met. Thus, award of an even higher rating is clearly not
warranted, and the claim is denied.
B. Mid-thoracic Back Strain
The veteran has complaints of pain in the area between his
shoulder blades, which he attributes to his duties as a
combat air crewman in CH-46 helicopters. His SMRs show a
complaint on the report of history provided at his January
2005 separation examination of "low middle back pain" for
the last five or six months. No related abnormality was
noted on clinical examination. At his June 2005 VA
examination he reported that he gets pain in the back that
can radiate into the neck and cause a headache type of pain
that radiates into the temples. He stated that there are
times when this hampers his ability to work out, but reported
no time lost from his duties in the preceding 12 months. He
was able to walk without limitation, and reported that there
was no radiation of pain into the upper extremities.
Examination revealed only minimal tenderness in the area
between the shoulder blades to deep palpation. There were no
muscle spasms. The veteran was afforded another VA
examination in January 2007 by the same physician that
yielded identical results.
The veteran's mid-thoracic back strain disability has been
evaluated utilizing the rating criteria found at Diagnostic
Code 5323, injuries in Muscle Group XXIII, whose functions
involve movements of the head; fixation of shoulder
movements; as well as muscles of the side and back of the
neck; suboccipital; lateral vertebral and anterior vertebral
muscles. 38 C.F.R. § 4.73. Under Diagnostic Code 5323, a
non-compensable (zero percent) rating is for application when
there is slight disability. A 10 percent rating is for
application when there is moderate disability, a 20 percent
evaluation is assigned for moderately severe disability, and
a 30 percent evaluation is assigned for severe disability.
The criteria for the evaluation of muscle groups are set
forth in 38 C.F.R. § 4.56. Under § 4.56(c), the cardinal
signs and symptoms of muscle damage are: loss of power,
weakness, lowered threshold of fatigue, fatigue-pain,
impairment of coordination, and uncertainty of movement.
The evaluation criteria consist of the type of injury, the
history and complaint, and the objective findings.
A slight disability of the muscles involves a simple wound of
muscle without debridement or infection. Any in-service
history of treatment must have been brief with return to duty
thereafter. There must be evidence of healing with good
functional results, and no cardinal signs or symptoms of
muscle disability as defined in § 4.56(c). Objective
findings must show minimal scarring, no evidence of fascial
defect, atrophy, or impaired tonus, and no impairment of
function or metallic fragments retained in muscle tissue.
A moderate disability of the muscles involves a through-and-
through or deep penetrating wound of a relatively short track
by a single bullet or small shell or a shrapnel fragment, and
the absence of explosive effect of high-velocity missile and
of residuals of debridement or of prolonged infection. There
must be evidence of in-service treatment, and there must be a
record in the file of consistent complaint of one or more of
the cardinal symptoms of muscle disability, particularly
lowered threshold of fatigue after average use, affecting the
particular functions controlled by the injured muscles.
Objective findings include scars, when present, and/or signs
of some loss of deep fascia, muscle substance, or impairment
of muscle tonus and loss of power or lowered threshold of
fatigue when compared to the sound side. 38 C.F.R. § 4.56.
Here, the Board finds that a compensable rating is not
warranted for the veteran's mid-thoracic back strain. While
the veteran's SMRs contain complaints related to the low
back, they are silent as to complaints related to the mid-
thoracic region and the area between the shoulder blades.
More significant, on post-service examination the only
reported finding was of minimal tenderness in the area
between the shoulder blades to deep palpation and the absence
of muscle spasms. As regards any limitations imposed on the
veteran, he reported to his examiner that there are times
that this hampers his ability to work out, but reported no
time lost from his duties as a result of this disability. He
was able to walk without limitation, and reported that there
was no radiation of pain into the upper extremities.
Moreover, the veteran fails to meet the threshold
requirements for a moderate disability as defined in § 4.56,
noted above. There is no evidence of in-service treatment.
There is no record in the file of consistent complaint of one
or more of the cardinal symptoms of muscle disability,
particularly lowered threshold of fatigue after average use,
affecting the particular functions controlled by the injured
muscles.
Absent any evidence that the veteran meets the criteria for
moderate disability as defined above, award of a compensable
rating is denied.
C. Low Back Strain
The veteran's SMRs contain his report of medical history
prepared in connection with his separation examination given
in January 2005. That history contains the veteran's
notation that he had a five to six-month history of middle
low back pain, with no history of trauma or any inciting
incident. The veteran reported no treatment and no
neurologic symptoms. The veteran's spine was found to be
normal on examination; the history of middle low back pain
was noted as not being considered disqualifying.
At his June 2005 VA examination, the veteran reported no time
lost from duties and no incapacitating episodes in the
preceding year due to his low back complaint. He described
very brief flare-ups, and experiencing a catching and a
tightness and spasm in the back if he twisted or bent wrong.
He reported that his ability to work out with heavy weights
had been somewhat impaired due to the potential of a back
spasm.
On examination, the veteran demonstrated some tenderness to
palpation over the left sacroiliac joint, but otherwise there
was no specific tenderness with palpation over the paralumbar
musculature or over the vertebral processes of the
lumbosacral spine. Range of motion of the thoracolumbar
spine revealed that the veteran was able to fully flex to 90
degrees, with some pulling and tightness from 70 to 90
degrees. Extension was to 30 degrees, and lateral flexion
and rotation were to 30 degrees bilaterally. There was very
mild pain at the end of range of motion throughout all of the
repetitive motion. There was no fatigability,
incoordination, or weakness, and no catch or spasm. The
examiner noted that there were no focal neurological
deficits. The veteran was afforded another VA examination in
January 2007 by the same physician that yielded identical
results, except that this time the examiner specifically
noted that there were no neurogenic bowel or bladder
abnormalities present.
The veteran's low back strain is evaluated utilizing the
rating criteria found at Diagnostic Code 5237, lumbosacral or
cervical strain, utilizing the General Rating Formula for
Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a. The
General Rating Formula is for use with or without symptoms
such as pain (whether or not it radiates), stiffness, or
aching in the area of the spine affected by residuals of
injury or disease. A note calls for evaluation of any
associated objective neurologic abnormalities, including, but
not limited to, bowel or bladder impairment, separately,
under an appropriate diagnostic code. As noted, examination
has revealed no associated neurological abnormalities.
Under the General Rating Formula, a 10 percent evaluation is
for application with forward flexion of the thoracolumbar
spine greater than 60 degrees but not greater than 85
degrees; or, forward flexion of the cervical spine greater
than 30 degrees but not greater than 40 degrees; or, combined
range of motion of the thoracolumbar spine greater than 120
degrees but not greater than 235 degrees; or combined range
of motion of the cervical spine greater than 170 degrees but
not greater than 335 degrees; or, muscle spasm, guarding, or
localized tenderness not resulting in abnormal gait or
abnormal spinal contour; or vertebral body fracture with loss
of 50 percent or more of the height.
Here, the veteran's range of motion of the thoracolumbar
spine is to 90 degrees in flexion, 30 degrees in extension,
and bilaterally to 30 degrees in both lateral flexion and
rotation. All of these ranges of motions are completely
normal as defined by VA regulation. 38 C.F.R. § 4.71a, Plate
V. Given that the veteran's range of motion of the
thoracolumbar spine is normal, and because the only
functional limitation appeared to be mild pain at the
extremes of motion, without incoordination, fatigue, or
weakness, the Board finds that a initial compensable rating
is not warranted, and the claim is therefore denied.
D. Shin Splints
The veteran's SMRs show that he complained of shin splints in
November 2003. The veteran was afforded a VA examination in
June 2005, at which he reported to his examiner that the left
was worse than the right, that he had flare-ups with
activities, and that he treated this with ibuprofen. He
reported that he could bicycle without difficulty, and that
bicycling did not produce flare-ups. He reported that he was
able to accomplish activities of daily living; running was
the most functionally impaired activity because this caused
flare-ups. On examination there was no abnormal swelling,
erythema, skin, or vascular changes. There was no tenderness
to palpation. There was negative Homans sign bilaterally.
The examination in January 2007 was essentially unchanged.
The veteran's bilateral shin splints have been evaluated by
analogy to the rating criteria found at 38 C.F.R. § 4.71a,
Diagnostic Code 5262, impairment of the tibia and fibula, or
malunion of the tibia and fibula with loose motion, requiring
the wearing of a brace. Under Diagnostic Code 5262, a 10
percent rating is for application when there is slight knee
or ankle disability. A 20 percent rating is for application
when there is moderate knee or ankle disability, and a 30
percent rating is for application when there is marked knee
or ankle disability.
Here, the medical evidence does not show that there is any
demonstrable knee or ankle disability or functional
equivalent that would warrant a compensable rating. The
Board has considered whether other diagnostic codes related
to the leg might allow for a compensable disability rating,
but finds none. Diagnostic Codes 5256 through 5261 relate to
the knee joints and/or their associated cartilage, and are
therefore inapt. Under Diagnostic Code 5263, a 10 percent
rating is applicable for genu recurvatum (backward curvature
of the knee), acquired through trauma, but the 10 percent
rating requires objective demonstration of weakness and
insecurity in weight-bearing for award. The record does not
show that there is any weakness and insecurity in weight-
bearing associated with the veteran's bilateral shin splints.
In sum, absent any demonstrable knee or ankle disability, or
any weakness and insecurity in weight-bearing, or pain that
causes functionally equivalent disabling manifestations, the
Board can find no basis on which to award a compensable
rating for the veteran's shin splints (right or left), and
these claims are therefore denied.
E. PTSD
The veteran provided the report of a June 2005 private
psychological evaluation authored by G. David Gruendel, Ph.D.
Dr. Gruendel reported that the veteran was oriented as to
person, place, and time. He appeared well-groomed and well-
developed. Mood was euthymic and range of affect normal. He
showed some appropriate signs of humor and some signs of
emotionality when describing his military experiences.
Speech was goal-directed, responsive, and not pressured, but
with a mild intensity. Thought content was normal with no
evidence of delusional or hallucinatory material. Thought
form was organized and judgment appeared intact. Insight was
judged to be fair to good. Suicidal ideation was denied.
Intelligence appeared above average, as was abstract
reasoning ability. His ability to do better on digits
backwards than forward suggested that his working memory was
excellent. The veteran's fund of general information was
determined to be average to slightly above average, as was
his performance on social comprehension.
The veteran reported that sleep was very difficult to achieve
immediately after leaving service, but that he now got five
and one half to six hours per night, though once or twice a
week he was not able to sleep at all. Sleep was said to be
disturbed by disturbing dreams related to his war
experiences. The veteran reported that he did not like being
around a lot of people, enjoying instead backpacking in
remote areas, or, instead of getting together with friends at
a bar, drinking at home alone. The veteran reported some
improvement in his symptoms over time. The examiner noted
that, because the veteran is a bright, highly motivated young
man, it was hoped that this improvement will continue. The
examiner also reported that the veteran described his family
as close. The veteran reported that, since discharge from
service he had been living with his family in Nebraska, but
that he planned to attend college in the fall.
A diagnosis was made utilizing the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) criteria. The DSM-IV Axis I (clinical
disorders and other conditions that may be a focus of
clinical attention) diagnoses were PTSD and alcohol abuse.
There was no diagnosis in Axis II (personality disorders and
mental retardation). The Axis III (general medical
conditions) diagnosis was undiagnosed knee injury (by
report). In Axis IV (psychosocial and environmental
problems) the examiner noted occupational, and that the
veteran was presently unemployed. The Axis V (global
assessment of functioning (GAF) score) report was 54.
The veteran was afforded a VA review examination in August
2006 to assess the degree of disability associated with his
PTSD. The veteran reported that he had begun treatment for
PTSD, but reported that treatment had not done much for him.
He reported taking no medications for his PTSD, and had not
had any hospitalizations for PTSD. His reported activities
included exercise, camping, playing with his dogs, and going
out with his fiancée. There was no history of suicide
attempts or of violence or assaultiveness. There was
reported good support in the area of psychosocial functional
status. There was no problematic effect with alcohol use,
and no issues associated with other substance use.
The veteran reported for his examination clean, neatly
groomed, and casually dressed. Psychomotor activity was
unremarkable. Speech was spontaneous and clear, and attitude
was cooperative, friendly, relaxed, and attentive. As to
affect, the veteran appeared to be in no distress; he sat
quietly in the interview and responded to specific questions.
He did not show signs of hyperarousal. Mood was described as
"sad" and "fear." Attention was said to be intact, but
the veteran refused to answer some questions, such as
spelling a word forward and backward, saying that he had
taken psychology courses and did not want to answer.
Thought process was described as quick and to the point. As
to judgment, the examiner noted that the veteran understood
the outcome of behavior. Intelligence was described as above
average. As to insight, the examiner noted that the veteran
understood that he has a problem. He reported impairment in
getting to sleep. He reported no hallucinations and
exhibited no inappropriate behavior. The veteran interpreted
proverbs appropriately. There was no obsessive/ritualistic
behavior, and no report of panic attacks or homicidal or
suicidal thoughts, and no reported episodes of violence.
Impulse control was good, and there were no problems with
activities of daily living. Remote, recent, and immediate
memory were all reported as normal.
The veteran reported chronic PTSD symptoms, including
persistent re-experiencing of his traumatic event, persistent
avoidance of stimuli, and persistent symptoms of increased
arousal. He became tearful in describing his experiences of
carrying bodies and dropping them off at mortuary affairs in
Iraq. He expressed anger, impatience, tears, guilt, a
feeling of not completing something, and said that those
feelings would not go away. He said he felt tired, fed up,
embarrassed, and ashamed, and that his fiancée was concerned
because she knows how unhappy he is. He reported that
drinking was a major problem for awhile, but that he no
longer was drinking as of three weeks earlier. Sleep was a
problem, but not as bad as it was when he first got home.
Dreams were reportedly less disturbing.
Now a student, he reported getting good grades. He also
reported that he was now working part time at a gym. He had
worked for two months at a saw mill, but quit in order to
keep up with school. He reportedly had missed not more than
a week to a week and a half from work in the past year,
though no specific reason was given for missing work. The
examiner reported that, based on psychometric data, the
degree of the veteran's PTSD symptoms was moderate.
The DSM-IV Axis I diagnosis was PTSD, chronic, and
depression, not otherwise specified. The depression was said
to be inseparable from the PTSD. There was no diagnosis in
Axis II. In Axis III, the examiner noted that the veteran
was service-connected for a number of physical conditions.
The examiner described the veteran's Axis IV problems as
mild. The Axis V GAF score was 58 for the present and for
the previous year. Commenting on the veteran's functional
status and his quality of life, the examiner noted that the
veteran's report indicates that the impact on relationships
has been the area most affected, but that he feels fortunate
that his family and friends have stuck with him. The veteran
also reported doing well in school and having no problems
related to employment. The examiner noted that the veteran's
condition had been persistent and was likely to continue, but
that treatment was likely to be very helpful. As to whether
the veteran's PTSD signs and symptoms result in deficiencies
in judgment, thinking, family relations, work, mood, or
school, the examiner answered "no." The examiner also
noted, however, that there was reduced reliability and
productivity due to PTSD symptoms related specifically to
family and social relations, where the veteran expressed a
belief that he has offended and alienated family and friends.
Finally, the Board notes that the record contains a mental
health treatment note dated in October 2006 that states that
the veteran reported improvement in his depression, and that
he had made major progress in addressing his drinking
problem. He stated that he had not had any PTSD flashbacks
in the daytime, and had not been having any significant
nightmares since starting medication. While reporting having
somewhat poor mood and having limited energy at times, he
denied any feelings of hopelessness, helplessness,
worthlessness, or guilt. Of particular note, wrote the
clinician, the veteran denied any suicidal or homicidal
ideations, or auditory or visual hallucinations or ideas or
reference. He denied any other chief complaints at the time.
The veteran was pleasant and cooperative throughout the
interview, and exhibited good grooming and hygiene. Speech
was clear and non-pressured, with appropriate syntax,
grammar, and content. He made strong eye contact throughout
the interview, and was interactive and inquisitive regarding
the nature of his medication regimen and nature of his
illness issues. He was oriented as to time, person, and
place, and in no acute distress. The veteran reported his
mood as "good." Affect was euthymic; thought processes
were logical, linear, and goal oriented; there was negative
flight of ideas or looseness of associations. The veteran
was negative for paranoia, but positive for some depressive
features; he denied obsessions, compulsions, delusions, or
special powers. Insight and judgment were both characterized
as fair. The examiner assessed major depressive disorder
with recurrent features versus PTSD.
PTSD is evaluated under 38 C.F.R. § 4.130, Diagnostic Code
9411. Under Diagnostic Code 9411, a 10 percent rating is for
consideration where there is occupational and social
impairment, due to mild or transient symptoms which decrease
work efficiency and ability to perform occupational tasks
only during periods of significant stress, or; symptoms
controlled by continuous medication.
A 30 percent rating is for consideration where there is
occupational and social impairment with occasional decrease
in work efficiency and intermittent periods of inability to
perform occupational tasks (although generally functioning
satisfactorily with routine behavior, self-care, and
conversation normal), due to such symptoms as: depressed
mood, anxiety, suspiciousness, panic attacks (weekly or less
often), chronic sleep impairment, mild memory loss (such as
forgetting names, directions, recent events.)
A 50 percent evaluation is warranted if the evidence
establishes there is occupational and social impairment, with
reduced reliability and productivity due to such symptoms as
flattened affect; circumstantial, circumlocutory, or
stereotyped speech; panic attacks more than once a week;
difficulty in understanding complex commands; impairment of
short and long-term memory (e.g., retention of only highly
learned material, forgetting to complete tasks); impaired
judgment; impaired abstract thinking; disturbances of
motivation and mood; difficulty in establishing and
maintaining effective work and social relationships. 38
C.F.R. § 4.130.
A 70 percent evaluation is warranted if the evidence
establishes there is occupational and social impairment, with
deficiencies in most areas, such as work, school, family
relations, judgment, thinking, or mood, due to such symptoms
as suicidal ideation; obsessional rituals which interfere
with routine activities; speech intermittently illogical,
obscure, or irrelevant; near-continuous panic or depression
affecting the ability to function independently,
appropriately, and effectively; impaired impulse control
(such as unprovoked irritability with periods of violence);
spatial disorientation; neglect of personal appearance and
hygiene; difficulty in adapting to stressful circumstances
(including work or a worklike setting); inability to
establish and maintain effective relationships.
38 C.F.R. § 4.130.
As noted in the introduction, the Board must consider whether
the evidence warrants a higher or lower rating at any point
during the pendency of the claim (so-called "staged
ratings"). Fenderson, supra. For the following reasons,
the Board finds that ratings higher than those assigned by
the RO are not warranted at any point.
For the period beginning from March 6, 2005, the Board finds
that the veteran's PTSD symptoms, based on the evidence of
record at the time of the initial rating, do not warrant an
evaluation higher than the 30 percent assigned by the RO.
The evaluation provided by the veteran's private examiner,
Dr. G., does not reveal evidence establishing occupational
and social impairment in any of the areas enumerated in the
50 percent rating criteria, with the exception of some
difficulty in establishing and maintaining effective work and
social relationships, which was not expounded upon. In this
regard, the Board notes that the veteran had only recently
left active duty, and was soon to enter school.
To the contrary, Dr. Gruendel reported that the veteran was
oriented as to person, place, and time, was well-groomed and
well-developed, and with euthymic mood and normal affect.
Speech was goal-directed, responsive, and not pressured.
Thought content was normal with no evidence of delusional or
hallucinatory material. Thought form was organized and
judgment intact. Insight was fair to good. Suicidal
ideation was denied. Intelligence appeared above average, as
was abstract reasoning ability. Memory was determined to be
excellent. The veteran's fund of general information was
determined to be average to slightly above average, as was
his performance on social comprehension. While the veteran
reported that sleep was very difficult, and he reported that
he did not like being around a lot of people, he also
reported he was living with his close family, and also had
some improvement in his symptoms over time. As noted, Dr. G.
assigned a GAF score of 54, indicating moderate symptoms.
In sum, the Board finds that the veteran's PTSD disability
picture more nearly approximates the criteria required for
the assigned 30 percent rating for the period beginning March
6, 2005, and that a higher award for that period is not
warranted.
Turning to the period beginning August 3, 2006, the Board is
at a loss as to the basis for award of the higher, 50
percent, rating assigned. Frankly, the Board finds that
there is little, if any, discernable difference in the
psychiatric evaluations rendered by Dr. Gruendel in June
2005, and the VA examiner in August 2006, on which the RO
based its increased award. Both examiners assigned GAF
scores in the 50s, suggesting the presence of moderate
symptoms. In fact, the more recent examination assigned a
higher GAF score, suggesting improvement in the veteran's
PTSD symptoms and their impact on the veteran's ability to
function. Nevertheless, the Board will assess whether a
rating higher than the awarded 50 percent is warranted
beginning August 3, 2006. For the following reasons, the
Board finds that a rating higher than 50 percent is not
warranted from August 3, 2006.
As noted, a 70 percent evaluation is warranted if the
evidence establishes there is occupational and social
impairment, with deficiencies in most areas, such as work,
school, family relations, judgment, thinking, or mood, due to
such symptoms as suicidal ideation; obsessional rituals which
interfere with routine activities; speech intermittently
illogical, obscure, or irrelevant; near-continuous panic or
depression affecting the ability to function independently,
appropriately, and effectively; impaired impulse control
(such as unprovoked irritability with periods of violence);
spatial disorientation; neglect of personal appearance and
hygiene; difficulty in adapting to stressful circumstances
(including work or a worklike setting); inability to
establish and maintain effective relationships.
Here, there is no evidence of deficiencies in most areas,
such as work, school, family relations, judgment, thinking,
or mood, and no evidence of symptoms such as suicidal
ideation, no obsessional rituals, and no speech that is
illogical, obscure, or irrelevant. There is no evidence of
any panic or depression affecting the ability to function
independently, appropriately, and effectively, and no
evidence of impaired impulse control. There is no evidence
of spatial disorientation or neglect of personal appearance
and hygiene. The fact that the veteran is reportedly doing
well in college, and has been able to maintain part-time work
while in school indicates that he is able to adapt to
stressful the circumstances of work and school. His success
in these areas, along with his engagement to his fiancée,
indicate his ability to establish and maintain effective
relationships.
Thus, for the period beginning August 3, 2006, the Board
finds that the veteran's PTSD disability picture does not
rise to the level of a 70 percent rating.
As previously discussed, the Board is unsure of the basis of
the 50 percent rating, especially given that the medical
evidence shows that the veteran's symptomatology had remained
essentially unchanged since the initial effective date of
March 6, 2005, and given that the most recently awarded
higher GAF score indicates that there may actually have been
improvement in his symptomatology. To be very clear, then,
the Board finds the criteria for a rating in excess of 30
percent for PTSD effective from March 6, 2005, and for a
rating in excess of 50 percent from August 3, 2006, have not
been met.
III. Service Connection
The veteran contends that he has a left shoulder disability,
left and right knee disabilities, a sinus disability, a neck
disability, and hearing loss, all of which he contends should
be service connected.
Service connection may be granted for disability resulting
from disease or injury incurred or aggravated during active
service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303.
Service connection may also be granted for any injury or
disease diagnosed after service, when all the evidence,
including that pertinent to service, establishes that the
disease or injury was incurred in service. 38 C.F.R.
§ 3.303(d). Generally, service connection requires (1)
medical evidence of a current disability, (2) medical
evidence, or in certain circumstances lay testimony, of in-
service incurrence or aggravation of an injury or disease,
and (3) medical evidence of a nexus between the current
disability and the in-service disease or injury. See Caluza
v. Brown, 7 Vet. App. 498 (1995). Certain chronic diseases,
including sensorineural hearing loss, may be presumptively
service connected if they become manifest to a degree of 10
percent or more within one year of leaving qualifying
military service. 38 C.F.R. §§ 3.307(a)(3); 3.309(a) (2006).
Further, it is not enough that an injury or disease occurred
in service; there must be chronic disability resulting from
that injury or disease. If there is no showing of a
resulting chronic condition during service, then a showing of
continuity of symptomatology after service is required to
support a finding of chronicity. 38 C.F.R. § 3.303(b).
A. Left Shoulder
The veteran's SMRs are silent as regards any complaint or
treatment of the left shoulder. Though he indicated on his
original claim that he was claiming service connection for a
left shoulder disability, he has not articulated the source
or the nature of the claimed disability, nor did he mention
any left shoulder complaint when examined in June 2005 or
January 2007. Here, this service connection claim must be
denied because there is no medical evidence of a current
disability, no medical evidence or credible lay evidence of
an in-service left shoulder injury or disease, and no medical
evidence of a nexus between the current disability and the
in-service disease or injury.
Where it is determined that the veteran was engaged in combat
with the enemy, VA shall accept as sufficient proof of
service connection the veteran's lay testimony regarding any
disease or injury alleged to have been incurred in or
aggravated by such service if consistent with the
circumstances, conditions, or hardships of such service,
notwithstanding that there is no official record of such
incurrence or aggravation in service, absent clear and
convincing evidence to the contrary. 38 U.S.C.A. § 1154(b)
(West 2002). Here, however, the veteran has not claimed that
a left shoulder injury was incurred while engaged in combat,
or even described what the averred injury is. In light of
the foregoing, the Board finds that the claim must be denied.
There is no suggestion of in-service disease or injury, or
current disability traceable to military service.
B. Knees
The veteran's SMRs are silent as regards any complaint or
treatment of the knees. Though he indicated on his original
claim that he was claiming service connection for left and
right knee disabilities, his claim did not describe the
nature of the claimed disabilities. Of record is a May 2005
letter from Chad Vieth, M.D., stating that the veteran has
bilateral knee discomfort that seems to be worse on the left.
Dr. Vieth stated that the veteran appeared to have some
chondromalacia-like symptoms that are a result of his posture
during his active duty as a door gunner. Dr. Vieth
reiterated that it was his opinion that the veteran's
bilateral knee discomfort, specifically of the left knee, is
a result of his active duty.
At his VA examination in June 2005, the veteran told his
examiner that he had pain in the knees, with the left
typically worse than the right. He attributed his knee
complaints to certain positions he was required to maintain
as a door gunner, and reported that there were times when he
had to walk stiff-legged because of the pain. Examination of
the knees revealed some very mild tenderness to deep
palpation over the anterior aspects of the parapatellar area.
Range of motion exercises revealed that the veteran was able
to extend the left knee to only five degrees, and flex to 110
degrees. He could fully extend the right knee to zero
degrees, and flex fully to 140 degrees. There was some mild
increase in pain to both knees with repetitive range of
motion exercises. There was minimal crepitus with range of
motion.
The veteran was afforded another VA examination of his knees
by an orthopedic surgeon in November 2005 to obtain a medical
nexus opinion as to whether his knee complaints were related
to his military service. That examiner noted the findings of
both Dr. Vieth and the June 2005 VA examiner, and addressed
each. As regards Dr. Vieth's note, the November 2005 VA
examiner noted that, other than his statement that it
appeared that the veteran had some chondromalacia symptoms,
it was very brief and did not go into detail. The November
2005 VA examiner noted that, as an orthopedic surgeon, he
deals with knees and other joints of the body on a daily
basis. He noted that chondromalacia is not a clinical
diagnosis obtained from a clinical physical examination, but
is instead a term commonly used to describe the arthroscopic
appearance of cartilage seen while doing joint arthroscopy,
and is graded based on the wear observed on the cartilaginous
surface. He noted that the medical literature supports this
definition.
This examiner noted that the veteran is a young man (age 24
at the time of examination), was in the military for less
than six years, had no medical evidence of any in-service
knee injury, and that recent x-rays from August 2005 were
completely normal. In light of these findings, the examiner
noted that it was less likely as not that the veteran's knees
conditions were caused by or a result of his reported in-
service bilateral knee injuries.
Here, there is medical evidence of a current disability,
identified as some limited range of motion in the left knee,
and an increase in pain bilaterally on repetitive motion.
However, there is no evidence of any in-service incurrence or
aggravation of an injury or disease. While the veteran
speculates that he has knee disabilities related to the odd
positions he was required to assume as a door gunner, he did
not cite any specific incident or incidents that could
credibly be reported by a layperson. Rather, his speculation
constitutes a medical opinion as to causation, and there is
no evidence of record showing that the veteran has the
specialized medical education, training, and experience
necessary to render competent medical opinion as to the
etiology of his disability. Espiritu v. Derwinski, 2 Vet.
App. 492 (1992); 38 C.F.R. § 3.159(a)(1) (2007).
Finally, there is no medical evidence of a nexus between the
current disability and the in-service disease or injury. As
noted, the veteran's own opinion in this regard is not
credible medical opinion. Moreover, the Board notes that the
medical opinion of the November 2005 VA orthopedic opinion is
that it is less likely as not that the veteran's knee
conditions were caused by or a result of his reported in-
service bilateral knee injuries. The Board finds that this
opinion, supported as it is by explanation, rationale, and
reference to the medical literature, is more probative than
Dr. Vieth's opinion, unsupported by a basis, explanation, or
rationale other than that it appeared that the veteran had
some chondromalacia symptoms that were attributable to his
active duty as a door gunner.
In light of the foregoing analysis, the Board finds that the
veteran does not have knee disability that is related to his
military service, and the claims are denied.
C. Sinus Disability
The veteran's SMRs are silent as regards any complaint or
treatment of a sinus-related disability. The veteran's
original claim of service connection did not describe the
nature or circumstances of his claimed sinus disability. The
report of the June 2005 VA examination found on examination
that the veteran's nose, sinuses, mouth, and throat were all
within normal limits. The examiner specified that there were
no abnormalities. The January 2007 examiner also noted that
there were no nose, sinus, or mouth/throat symptoms present.
An October 2005 VA examining physician's opinion was that the
veteran's headaches were at least as likely as not related to
his service-connected right shoulder strain and mid-thoracic
back strain, with no attribution to a sinus disability.
The existence of a current disability is the cornerstone of a
claim for VA disability compensation. 38 U.S.C.A. § 1110,
1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997)
(holding that interpretation of sections 1110 and 1131 of the
statute as requiring the existence of a present disability
for VA compensation purposes cannot be considered arbitrary).
Evidence must show that the veteran currently has the
disability for which benefits are being claimed.
Here, there is no medical evidence of a current sinus
disability. There are no current treatment records showing
complaints of, or treatment for, any sinus disability, and
the report of the June 2005 and January 2007 examinations
explicitly noted that there were no abnormalities found.
With no medical evidence of the claimed disability, the
analysis ends, and service connection must be denied.
D. Neck Disability
The veteran's SMRs are silent as regards any complaint or
treatment of a neck injury or disease. The veteran's
original claim of service connection did not describe the
nature or circumstances of his claimed neck disability. The
June 2005 and January 2007 VA examinations reported nothing
related to the neck. As noted, the October 2005 VA examining
physician determined that the veteran's headaches are at
least as likely as not related to his service-connected right
shoulder strain and mid-thoracic back strain. Moreover, this
examiner noted that it was well known in the medical
literature that these types of muscle strain can easily
cascade to the posterior cervical spine, causing tension and
muscle contraction-type headaches, which can easily cause the
discomfort the veteran reported.
As noted, the evidence must show that the veteran currently
has the disability for which benefits are being claimed.
Here, there is no medical evidence of a current neck
disability. There are no current treatment records showing
complaints of, or treatment for, any neck disability. With
no medical evidence of the claimed disability, the analysis
ends, and service connection must be denied.
E. Hearing Loss
The veteran contends that he should be service connected for
bilateral hearing loss. The veteran's SMRs contain numerous
audiological evaluations, all of which note that the veteran
was routinely exposed to noise. All of those in-service
reports of audiological evaluation also show normal hearing
as defined by the VA criteria described below. Given that
the veteran was an air crewman in helicopters, his exposure
to acoustic trauma in service is conceded.
The veteran submitted the report of a private audiological
evaluation conducted by Craig Foss, Au.D., in July 2005. Dr.
Foss reported that pure tone thresholds, in decibels, were as
follows:
HERTZ
500
1000
2000
3000
4000
RIGHT
10
5
5
10
10
LEFT
15
10
5
5
10
Speech audiometry, as measured by the Maryland CNC, revealed
speech recognition ability of 100 percent in both ears. In a
letter to the veteran providing the results of his
evaluation, Dr. Foss noted that the results showed that the
veteran has normal hearing acuity bilaterally.
As noted, service connection generally requires (1) medical
evidence of a current disability, (2) medical evidence, or in
certain circumstances lay testimony, of in-service incurrence
or aggravation of an injury or disease, and (3) medical
evidence of a nexus between the current disability and the
in-service disease or injury. Caluza, supra.
For the purposes of applying the laws administered by VA,
impaired hearing is considered to be a disability when the
auditory threshold in any of the frequencies 500, 1000, 2000,
3000, and 4000 Hertz is 40 decibels or greater; or when the
auditory thresholds for at least three of those frequencies
are 26 decibels or greater; or when speech recognition scores
using the Maryland CNC Test are less than 94 percent. 38
C.F.R. § 3.385.
Here, there is no medical evidence of a current hearing loss
disability. As noted, the results of his June 2005
audiological evaluation showed that he has normal hearing as
defined by VA regulations. Moreover, his private audiologist
specifically stated that the veteran has normal hearing
acuity bilaterally. With no medical evidence of the claimed
disability, the analysis ends, and service connection must be
denied.
The Board has considered the benefit-of-the-doubt doctrine,
but finds that the record does not provide even an
approximate balance of negative and positive evidence on the
merits for any of these service connection claims. 38
U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski,
1 Vet. App. 49 (1990). Therefore, on the basis of the above
analysis, and after consideration of all the evidence, the
Board finds that the preponderance of the evidence is against
these service connection claims. The veteran does not have a
left shoulder disability, a left or right knee disability, a
sinus disability, a neck disability, or hearing loss that is
related to his military service.
ORDER
Entitlement to an increased evaluation for right shoulder
strain, currently rated as 20 percent disabling, is denied.
Entitlement to an initial compensable evaluation for mid-
thoracic back strain is denied.
Entitlement to an initial compensable evaluation for left
shin splints is denied.
Entitlement to an initial compensable evaluation for right
shin splints is denied.
Entitlement to an initial compensable evaluation for low back
strain is denied.
Entitlement of a higher initial evaluation for post-traumatic
stress disorder, rated as 30 percent disabling from March 6,
2005, and as 50 percent disabling from August 3, 2006, is
denied.
Entitlement to service connection for a left shoulder
disability is denied.
Entitlement to service connection for a left knee disability
is denied.
Entitlement to service connection for a right knee disability
is denied.
Entitlement to service connection for a sinus disability is
denied.
Entitlement to service connection for a neck disability is
denied.
Entitlement to service connection for hearing loss is denied.
________________________________
MARK F. HALSEY
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs